High rates of asymptomatic neurocognitive impairment are observed in perinatally HIV-infected adolescents

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Sarah Gladys Mathews
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1 High rates of asymptomatic neurocognitive impairment are observed in perinatally HIV-infected adolescents YasotharanParamesparan, Jane Ashby, Lucy Garvey, Caroline Foster, Sarah Fidler, Alan Winston Background to problem Rates of Cerebral HIV disease Changing Epidemiology Neurocognitive performance in Charter Cohort n= any CNS event PML TOXO CRYP HIVe 30% 47% 2% Normal Mild neurocognitive impairment Moderate impairment /7 1998/9 2000/1 2002/3 2004/5 2006/7 21% Severe neurocognitive impairment Garvey et al PS6/5 Cologne EACS November 2009 Heaton et al. HIV-associated neurocognitive impairment remains prevalent in the era of combination ART: the CHARTER study. 16th Conference on Retroviruses and Opportunistic Infections. February 8-11, Montreal. Abstract

2 Aims of our study To assess rates and characteristics of neurocognitiveimpairment (NCI) in a modern HIV infected cohort. To compare rates of NCI between different age groups Study Design Prospective pilot study (undertaken between ) Inclusion criteria HIV infected Patients to be on stable antiretroviral therapy Undetectable plasma viral load (HIV RNA <50 copies/ml) for at least three months Exclusion criteria Presence of neurological disease (e.gpatients with cognitive decline or any symptoms of memory loss) Hepatitis C co-infection Current usage of drugs of misuse Recruitment for our study was carried out when patient came in for clinic appointments. Patient carried out tests during their free time 2

Testing Methods Pt presses the Yeskey as soon as the blue card has turned

Marked interference with daily life Symptomatic NCI impairment >1 SD in 2

impairment >1 SD in 2 or more domains * does not interfere with daily life

abilities: verbal/language; attention/working memory;

3 Testing Methods Pt presses the Yeskey as soon as the blue card has turned over Definition of NCI Neurology 2007;69; No NCI Normal HAD Marked interference with daily life Symptomatic NCI impairment >1 SD in 2 or more domains * does interfere with daily life Asymptomatic NCI impairment >1 SD in 2 or more domains * does not interfere with daily life * The neuropsychological assessment must survey at least the following abilities: verbal/language; attention/working memory; abstraction/executive; memory (learning; recall); speed of information processing; sensory-perceptual, motor skills 3

4 Our Definition of NCI Neurology 2007;69; No NCI Normal Asymptomatic NCI impairment >1 SD in 2 or more domains * does not interfere with daily life * The neuropsychological assessment must survey at least the following abilities: verbal/language; attention/working memory; abstraction/executive; memory (learning; recall); speed of information processing; sensory-perceptual, motor skills Statistical Considerations Carried out using SPSS Data analysed using three groups: 1. Perinatally acquired HIV adolescents (PaHIV) 2.Younger Adult-acquired HIV infected patients age 24-59yrs (YaHIV). 3.Older Adult-acquired HIV infected patients age 60+ (OaHIV) Data analysis under Linear regression (univariateand multivariate) 4

5 Results: Baseline characteristics of populations Mean (SD) unless otherwise stated Group 1 PaHIV Group 2 YaHIV Group 3, OaHIV Number of subjects Age, years (mean, range) 18 (17-23) 44 (24-59) 64 (60-77) Male gender, n(%) 2 (33) 31(84) 38 (97) Current plasma CD4+count (cells/ul, SD) 618 (229) 572(277) 546 (241) Nadir plasma CD4+count (cells/ul, SD) 393 (241) 184(134) 173 (110) Percentage NCI NCI,(number) [%] Results: Neurocognitive impairments Bar chart showing the percentage of Pts with NCI 80% 70% 60% 50% 40% 30% 20% 10% 0% 4/6 67% 13/37 35% N=82 Group 1:PaHIV Group2: YaHIV Group 3:OaHIV 7/39 18% Trends of NCI in Adult cohorts: 1. Younger age p=0.04 5

6 %Pts >1SD poorer than normal MEAN Individual domain analysis Graph showing the proportion of patients performing more than 1SD poorer than our control population mean Reaction speed in detection domain Reaction speed in monitoring domain Learning speed in games Learning accuracy Complex learning PaHIV YaHIV OaHIV Conclusion High rates of asymptomatic NCI observed in HIV individuals on stable antiretroviral therapy In adults with HIV younger age was statistically associated with NCI In a very small cohort of perinatallyinfected adolescents high rates of NCI 6

7 Our Definition of NCI Performance of pt in an individual neurocognitive domain Normal Population Mean Below Average Above Average This area marks Performance poorerthan one standard deviationbelow the normal population mean This line marks one standard deviation below Normal Population Mean 7

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